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BMJ. 2015 May 14;350:h2145. doi: 10.1136/bmj.h2145.

Physical activity for smoking cessation in pregnancy: randomised controlled trial.

Author information

Population Health Research Institute, St George's University of London, London SW17 ORE, UK
Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Obstetrics and Gynaecology, St George's University of London and St George's NHS Trust, London, UK.
Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
Department of Family and Preventive Medicine, University of California, San Diego, CA, USA.
Population Health Research Institute, St George's University of London, London SW17 ORE, UK.
Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, UK.
Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
Division of Primary Care and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK.



To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy.


Parallel group, randomised controlled, multicentre trial.


13 hospitals in England, April 2009 to January 2014.


789 pregnant smokers, aged 16-50 years and at 10-24 weeks' gestation, who smoked at least one cigarette daily and were prepared to quit smoking one week after enrollment were randomised (1:1); 785 were included in the intention to treat analyses, with 392 assigned to the physical activity group.


Interventions began one week before a target quit date. Participants were randomised to six weekly sessions of behavioural support for smoking cessation (control) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations.


The primary outcome was continuous smoking abstinence from the target quit date until end of pregnancy, validated by exhaled carbon monoxide or salivary cotinine levels. To assess adherence, levels of moderate-vigorous intensity physical activity were self reported and in a 11.5% (n=90) random subsample of participants, physical activity was objectively measured by an accelerometer.


No significant difference was found in rates of smoking abstinence at end of pregnancy between the physical activity and control groups (8% v 6%; odds ratio 1.21, 95% confidence interval 0.70 to 2.10). For the physical activity group compared with the control group, there was a 40% (95% confidence interval 13% to 73%), 34% (6% to 69%), and 46% (12% to 91%) greater increase in self reported minutes carrying out physical activity per week from baseline to one week, four weeks, and six weeks post-quit day, respectively. According to the accelerometer data there was no significant difference in physical activity levels between the groups. Participants attended a median of four treatment sessions in the intervention group and three in the control group. Adverse events and birth outcomes were similar between the two groups, except for significantly more caesarean births in the control group than in the physical activity group (29% v 21%, P=0.023).


Adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy. During pregnancy, physical activity is not recommended for smoking cessation but remains indicated for general health benefits. Trial registration Current Controlled Trials ISRCTN48600346.

[Indexed for MEDLINE]
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